Abstract

Background

While health outcomes of HIV/AIDS treatments in terms of increased longevity has been the subject of much research, there appears to be very limited research on
the improved health related quality of life (HRQL) that can be applied in cost-utility analyses in Africa south of the Sahara
(SSA). Most of the literature that does exist present HRQL measured by disease specific
instruments, but such data is of little use as input to economic evaluations.

Methods

A systematic review of the literature on HRQL weights for people living with HIV/AIDS
in Africa was performed, and the findings are presented and interpreted. We also use
focus group discussions in panels of clinical AIDS experts to test the preference
based on a generic descriptive system EQ-5D. We contrast quality of life with and
without antiretroviral treatment (ART), and with and without treatment failure.

Results

In only four papers were the HRQL weights for HIV/AIDS in sub-Saharan Africa estimated
with generic preference based methodologies that can be directly applied in economic
evaluation. A total of eight studies were based on generic health profiles. While
such 'health profiles' are not preference based, the scores could potentially be transformed
into health state utilities. Most of the available literature (20 papers) utilized
disease specific instrument, which are not applicable for economic evaluation.

The focus group discussions revealed that HRQL weights are strongly correlated to
disease stage. Furthermore, clinical experts consistently report that ART has a strong
positive impact on the HRQL of patients, although this effect appears to rebound in
cases of drug resistance.

Conclusions

EQ-5D appears to be an appropriate tool for measuring and valuing HRQL of HIV/AIDS
in Africa. More empirical research is needed on various methodological aspects in
order to obtain valid and reliable HRQL weights in economic evaluations of HIV/AIDS
prevention and treatment interventions.